4 Signs your Shoulder Pain requires Urgent Medical Attention

By  admin6  published  February 21, 2018

Shoulder pain can happen for so many different reasons, it is important to know the difference between something that would go away by itself or something serious that requires medical attention.

Let us understand when your shoulder pain requires an urgent trip to the doctor.

1. If your shoulder seems popped or out of place, especially after an injury or accident, this requires immediate medical attention. Out of place shoulder could indicate ligament tears that would threaten shoulder stability.

2. A popping or clicking sensation may be a sign of a labral tear, which may require surgery to fix.

3. If you are not able to lift your arm pain free, it is time to see a doctor. It could indicate a rotator cuff injury which often requires surgery.

4. If your shoulder pain is not due to a trauma but due to overuse or aging, it is important to note any changes in the severity of pain and range of motion. Increasingly worsening pain could be an indication of arthritis. Getting timely medical help for early diagnosis and treatment of arthritis can delay its progression.

If you simply not sure, seek professional medical advice anyway. Seemingly harmless discomfort and pain may worsen and turn chronic, if left untreated. So, it is best to see an experienced orthopedic surgeon right away.

Continue Reading

When Is Shoulder Arthroscopy A Better Option Than Open Surgery?

By  aenriquez  published  January 29, 2018

Subacromial decompression is a surgery that treats shoulder impingement syndrome and can be done through an open incision or arthroscopically.

Surgeries such as open decompression or arthroscopy have almost the same results in a reduction in pain ranging in almost 77-90 percent of the patients. The methods to be used are dictated largely by the surgeon’s preferences and the condition of the patient.

Arthroscopic Surgery for wellness

Arthroscopic surgery

A minimal two to three small cuts are made surrounding the shoulder during the surgery. An arthroscope, which is a small viewing device is inserted in the cut. The surgeon can look inside through the camera and check the biceps and joints along with the rotator cuff tendons to any issues that can otherwise be overlooked or go unnoticed in an MRI or an open procedure.

Arthroscopic surgery is generally recommended for people who are young and have a mild impingement in the shoulder. It is done to promote regaining of daily activities. Moderate shoulder impingement refers to pain which hinders daily life activities. It often occurs in individuals around the age of 25 to 40 years old.

When is it not recommended?

It is generally not recommended for people who experience the following:

  • Existing shoulder problem
  • Have a large tear in the rotator cuff which is medically proven as unrepairable. Patients who have such significant injuries can only be treated with open surgeries.
  • Individuals with a flat acromion or tissue inflammation like tendonitis in the rotator cuff, which is not due to shoulder impingement but rather the cause.

Open Surgery

This procedure involves a large incision of about 4-6 cm. It is necessary for patients who have a large rotator cuff tear. In many cases, surgeons recommend open surgeries compared to other options as it allows them access to a large area of injury. On the other hand, however, a large incision increases the chance of infection. Patients who undergo open surgery may have to spend 1-2 nights in the hospital for recovery.

Open Surgery vs Arthroscopic

Open surgeries are for external rotation while arthroscopic procedures are linked with less motion. Open surgery can be performed faster, while arthroscopic procedures require a detail-oriented set of skills.

Many surgeons are comfortable with open surgeries for the latter can be a difficult procedure.  Recovery time varies for both, and in general, takes 3-6 months to fully recover. People may be able to use the affected arm by two weeks of the surgery.

It is reported that people who go through arthroscopic surgery recover faster, and experience less pain during the recovery period. The recovery process involves stretching and exercise that prevents swelling and stiffness. In both cases, a therapist would likely be involved to assist the patient with exercises that promote healing and recovery.

Risks

There are potential risks of both types of surgeries, including:

  • Chronic shoulder pain and stiffness
  • Damage to the nerves or blood vessels
  • Infection  (less risk in arthroscopic compared to open surgery)

 

Continue Reading

Platelet Rich Plasma Therapy Can Delay Knee Replacement Surgery

By  admin6  published  January 25, 2018

Osteoarthritis is a degenerative condition that gradually wears away the protective joint cartilage. It is the most common form of arthritis and has no cure till date. However, several conservative and interventional pain management methods can help to reduce pain and delay progression.

Treatment options include physical therapy, prescription pain medications, steroid injections, or joint replacement surgery. But regenerative medicine has given us a new treatment called platelet-rich plasma (PRP) therapy which may help to delay the need for surgery in moderate arthritis cases.

PRP therapy uses the patient’s own blood for its healing properties. The patient blood sample is drawn and filtered. Platelets are then concentrated. Platelets produce a high concentration of essential growth factors which initiate a natural healing response. The extraction and injection, both, are relatively painless. The growth factors can repair the degenerative cartilage, reduce inflammation and relieve pain.

Patients need to undergo treatments for about 4 to 6 weeks. The basic aim of PRP is to assist repair and build up damaged and worn out tissues.

Since the platelets are extracted from the patient’s own blood, there are virtually no risks of infection and rejection.

If you are experiencing knee pain due to osteoarthritis and don’t want it to prevent you from living a healthy, active life, ask your orthopedic doctor about PRP therapy.

Continue Reading

What Makes an Orthopedic Surgeon “The Best”?

By  aenriquez  published  January 2, 2018

Orthopedic surgery is one of the most competitive medical specialties. These surgeons work to fix musculoskeletal issues, for instance like a torn ACL in an athlete or perform a hip replacement in an elderly patient with osteoarthritis.  If you have a sports injury or are in need of an orthopedic surgeon, you will probably find yourself googling “best orthopedic surgeons”. But how do you actually know somebody is the best at what they do? Coming from a non-medical background it is incredibly difficult to work out whether somebody is truly the best. But new research gives us a sneak peek into the inner workings of those that are at the top of the orthopedics game.

Tempe shoulder surgeon

A recent study by doctors in Canada looked at what makes a highly successful orthopedic surgeon. It was published in the Journal of Bone and Joint Surgery, so is probably inaccessible to the average patient looking up the best orthopedic surgeons.  The authors looked to those at the top of the profession, those with academic departmental chairs, journal editors, past or current presidents of major orthopedic associations. They defined these are the best as they had risen to the very top of the profession, and presumably, the best surgeons will have similar characteristics as these doctors (but may be much younger and not have reached such heights yet). This information should be accessible to the general public, so below is a list of characteristic identified by the Doctors that you should look out for.

 

  • Research Research Research: The authors found that 30% had over 100 publications of book chapters, clinical research etc. Being involved in pushing the practice forward, in a sense being an innovator, was significantly associated with success. Look out for doctors who are heavily involved in research.
  • They want to be the best at surgery, not the richest: This might be slightly harder to spot, but these individuals were identified as having a desire to develop themselves as surgeons much more than they were interested in financial gain.
  • Are they happy?: Happiness was identified as the third characteristic. Those that enjoyed the work they did were likely to be successful.
  • Healthy Lifestyle: Again, this might be slightly difficult to identify in prospective surgeons, but a healthy lifestyle seemed to correlate with being a successful surgeon. Presumably, those that know how to look after themselves also know how to look after you.

 

Other things to look out for

 

However, the study does note that it did not take into account patient experience and statistics on surgeries. Therefore they did not account for some things in the survey. Other things to look out for in the best doctors could be:

 

  • Patient satisfaction: It’s not everything, but it can be a real indicator of a fantastic doctor. Many sites provide reviews to look through of physicians in your area. Also look out for Docs who have been awarded Patients Choice Awards. Those with multiple awards have shown year on year satisfaction in their patients.
  • Years of experience: Again, it’s not everything and some less experienced surgeons can be fantastic, but it’s definitely something to take into consideration.

 

In conclusion, meet prospective surgeons and look at their careers holistically to make a decision.

 

Continue Reading

Top 6 Signs you may need a Knee Replacement Surgery

By  admin6  published  December 28, 2017

The number of total knee replacements continues to rise. Despite the long recovery process, an increasing number of people believe that a knee replacement surgery can help them live a better life.

But how do you know you need a knee replacement surgery? Read on for answers.

Patients, and doctors, prefer conservative and minimally invasive treatment options for any health problems and knees are no exception. Many times, the best treatment option is to undergo total or partial knee replacement.

Telltale Signs you need Knee Replacement Surgery

  • Severe knee pain that interferes with or even prevents everyday activities
  • The pain persists even during rest; you feel moderate to severe pain at all times
  • Knee swelling and inflammation that have become stubborn
  • Knee stiffness
  • Bowing of the leg
  • Non-steroidal Anti-inflammatory drugs fail to provide pain relief.

These signs are serious. Do not allow them to become worse. If you experience one or more of these warning signs, consult an orthopedic surgeon immediately.

Left untreated, these symptoms may give way to even more serious problems, such as –

  • Weakened knee muscles and ligaments
  • Knee deformities
  • Loss of motion and function in the knee
  • Knee joint degeneration
  • Delayed knee surgery may not prove as effective as it can when performed early
Continue Reading

What are Lateral Collateral Ligament Injury Symptoms that need Surgery?

By  aenriquez  published  December 27, 2017

Knee Ligament InjuryLateral collateral ligament (LCL) injury often requires reconstructive surgery. LCL reconstruction is necessary to avoid rotational instability of the knee and cartilage damage. The extent of damage can affect the outcome of surgery. Certain symptoms exist that make surgery necessary. Our orthopedic surgeons are able to reattach the ligament with sutures or reconstruct it using donor tissue.

The lateral collateral ligament is one of the four major ligaments of the knee. The LCL is outside of the knee, and it connects the femur (thigh bone) to the fibula (lower leg bone). The LCL’s main function is to avoid varus stress across the knee (buckling outward). Together with the popliteofibular ligament, the joint capsule, and the popliteus tendon, these structures form the PLC complex, which gives you external rotational stability.

 

LCL Injury and Symptoms

Lateral collateral ligament injury symptoms vary from person-to-person. Injuries to the LCL and posterior lateral corner occur from a rotational force across the knee. A contact injury is a direct blow to the inside of the knee, whereas a non-contact injury is caused from hyperextension stress. The symptoms of LCL injury include:

  • Swelling and tenderness along the outside of the knee
  • Pain that can be mild to moderate
  • Feeling that the knee will give way under stress
  • Numbness or weakness of the foot related to the peroneal nerve, which is near the ligament stretched during injury

 

Can you Walk with a Torn LCL?

A torn lateral collateral ligament can produce severe pain and limit movement, depending on the severity of the injury. However, some people can walk following an injury or tear to the LCL. The doctor will grade the tear based on symptoms. A careful eye is needed to diagnose a posterolateral and lateral injury. The doctor will check for:

  • Ecchymosis and skin abrasions on the side of injury
  • Pain on palpation
  • Difficulty ambulating
  • Loss of normal knee movement

Diagnosis and grading of the tear are confirmed using a magnetic resonance imaging (MRI) scan. An MRI has a 90% accuracy for showing tears of the posterolateral corner and ligaments. To isolate the LCL, the doctor will apply stress during flexion and compare the knee to the other one. Signs that the knee requires surgery include a positive prone “dial” sign, problems with foot eversion and inversion, and severe tearing found during arthroscopy.

LCL Surgery for Tears and Injury

The lateral collateral ligament does not heal as well as the medial collateral ligament. For a minor tear, non-surgical treatment is used (bracing, rest, and ice). For high-grade acute tears, the ligament must be surgically reattached to the femur or fibula, depending on the situation. Surgical management includes open reconstruction using an allograft (donor material) or autograft (from the patient). The mini-open surgery involves a tiny incision and use of special tools and a camera to repair the ligament. The ends can be sewed together in certain cases where the ligament is torn into two pieces.

For a ruptured ligament, the surgeon will evaluate the situ1ation and make a surgical plan. Be sure to discuss all options with the orthopedic specialist and inquire about alternative therapies. When surgery is required, expect to have 4-12 weeks of recovery, which involves working with a physical therapist to regain strength and function of the knee.

Resources
King AH, Krych AJ, Prince MR, Pareek A, Stuart MJ, Levy BA. Surgical Outcomes of Medial Versus Lateral Multiligament-Injured, Dislocated Knees. Arthroscopy. 2016 Sep;32(9):1814-9. 
Yuuki A, Muneta T, Ohara T, Sekiya I, Koga H. Associated lateral/medial knee instability and its relevant factors in anterior cruciate ligament-injured knees. J Orthop Sci. 2016 Nov 19. pii: S0949-2658(16)30217-2. doi: 10.1016/j.jos.2016.10.009.
Continue Reading

When do you Need a Bankart Repair?

By  aenriquez  published  December 17, 2017

Painful Shoulder InjuryA Bankart lesion is a common shoulder injury. This type of shoulder injury often requires Bankart repair. This lesion is when the anterior and inferior portion of the labrum (band of cartilage) is torn away from the glenoid (portion of the joint socket. Bankart repair recovery ranges from six to nine weeks, and the procedure can be extensive, depending on the extent of the injury.

The shoulder joint is a combination of many joints that work together. The glenohumeral joint is where the humerus (upper arm bone) attaches to the scapula (shoulder blade) body. The area where the scapula meets the humerus is called the glenoid fossa. Along with this structure is the labrum, which is a tough band of cartilage. The role of the labrum is to deepen the socket to allow greater congruence between these structures.

 

Bankart Repair Success Rate

A Bankart lesion often occurs along with anterior shoulder dislocation. The shoulder may be continuously moved forward or anteriorly. The Bankart lesion can lead to further shoulder joint damage or injury to other areas of the shoulder. Bankart lesion repair is a surgery used to reconnect the torn labrum to the glenoid fossa, which repairs and stabilizes the joint to prevent further dislocations.

The most common surgical technique for the treatment of anterior shoulder instability is the arthroscopic Bankart repair or the open repair method. In a study evaluating the outcomes of these procedures, researchers reviewed 28 clinical trials. They also reviewed outcome measures, pain scores, dislocation rate, and other problems. The estimated re-dislocation rate was 15% following arthroscopic repair and only 7% following the open Bankart repair.

 

Bankart Repair Recovery

The rehabilitation process following a Bankart repair begins almost immediately. Within the first few days after surgery, passive range of motion starts through physical therapy. The physical therapist and doctor discuss what moves and measures to take for rapid recovery. A sling is only prescribed for use during showering and dressing changes. No internal rotation is allowed for several weeks. Other therapies used for pain control are massage and electrical stimulation.

For the first four weeks after the Bankart repair, the therapist focuses on helping you regain as much range of motion as possible. During this time, the shoulder strength will also improve and shoulder pain should decrease. After four weeks, the focus is on regaining shoulder strength and function. The patient must continue to work with the physical therapist to regain full function and range of motion of the shoulder.

 

Bankart Repair Protocol

Regardless of how the labrum was torn, the surgeon will work with you to decide on the best possible treatment. For many patients, Bankart tears are successfully treated with anti-inflammatory measures, rest, physical therapy, and activity modification. When conservative measures fail to restore function, the doctor may suggest Bankart repair. Labral repair involves re-anchoring, suturing, and/or trimming away torn pieces of cartilage. The procedure is most often performed arthroscopically, and most patients go home the same day as the surgery.

 

The time it takes to recover after a Bankart repair varies from person-to-person. It typically takes 4-6 months for full recovery. For some patients, it can take a full year to full recovery. People with desk jobs must take1-2 weeks off from work. For those who lift and do labor type jobs, plan on being out of work for up to 6 months. Postoperatively, you will see the doctor in 5-10 days, and physical therapy usually begins soon after your procedure. You can use ice 3-6 times each day for 20-minute intervals for pain and swelling and must wear a sling for the first 2 weeks.

 

Resources
Rollick NC, Ono Y, Kurji HM, et al. (2017). Long-term outcomes of the Bankart and Latarjet repairs: a systematic review. Ortho Surg, 8, 97-105.
Continue Reading

What is the Difference between Reverse Shoulder Replacement and Conventional Shoulder Replacement?

By  aenriquez  published  December 13, 2017

A shoulder replacement is used to replace the shoulder socket with a high-density metal or plastic cup. The upper part of the arm is fitted with a meal ball to allow the shoulder natural function. Two options for replacing a damaged joint is the conventional (traditional) shoulder replacement and the reverse shoulder replacement. Shoulder surgery started in the United States in the mid-1950s, and it was first use for severe shoulder fractures. Around 23,000 Americans have shoulder surgery each year.

 

Shoulder Replacement SurgeryWho Needs Shoulder Replacement Surgery?

Certain conditions and factors increase your risk for shoulder replacement surgery. These include:

  • Osteoarthritis is the most common reason for shoulder replacement surgery. A type of wear-and-tear arthritis, osteoarthritis usually affects older people. Over time, the shoulder joint becomes painful and stiff.
  • A severe shoulder fracture is a common reason for a shoulder replacement procedure. When the head of the upper arm bone is shattered, the blood flow is interrupted.
  • Patients with long-standing rotator cuff tear can develop cuff tear arthropathy.
  • Finally, avascular necrosis leads to lack of blood flow to the shoulder, which can lead to humeral head death.

 

Reverse Shoulder Replacement VS. Conventional Shoulder Replacement

When there is significant damage to the rotator cuff and deterioration of the shoulder’s normal structure, a reverse shoulder replacement is the best option. With this procedure, the ball and socket are positioned in the opposite positions. The metal ball is attached to the shoulder, and the socket component is placed on the upper portion of the humerus (upper arm bone).

With the traditional shoulder replacement, the metal ball is attached to the upper arm bone, and the plastic socket is attached to the shoulder bone. The surgery is highly technical, and each case is treated uniquely. The implants are smoothed using special tools to fit your body, and the surgeon carefully assesses each patient individually.

 

Reverse Shoulder Replacement Rehab

A careful and well-planned rehabilitation program is crucial to the success of shoulder replacement. You are started on gentle physical therapy the day of or after your procedure. You will wear an arm sling for the first several weeks after surgery, but start using the arm in a few days, and then only at night for 4-6 weeks. Most patients are performing activities of daily living (dressing, eating, grooming) around 2 weeks post-surgery.

The physical therapist will meet with you 2-4 times each week to learn exercises for flexibility, function, and strength. You should avoid placing your arm in an extreme position, such as behind your body, for at least 6 weeks. In addition, you cannot do heavy lifting or sports for 8-12 weeks. Be sure to not overuse the joint, which may result in severe motion limitations.

Continue Reading

Reduce the Ongoing Risk of Arthritis – The Importance of Healing Damaged Knee Ligaments

By  aenriquez  published  December 6, 2017

Ongoing Risk of ArthritisAs the largest and perhaps most important joint in the body, the knee joint is an easy one to injury. Through twisting or moving awkwardly, there can be a strain on the joint and even if overusing, this can create knee pain. The knee joint takes a great deal of pressure and weight-bearing and this, along with natural aging are all likely causes of joint problems. Mild strains are likely where the tissues of the knee are stretched but minor aches and pains are unlikely to need medical assistance. Protecting, resting and using ice to relieve any inflammation is wise but ensuring flexibility is maintained and good muscular strength is present around the knee joint will help in a preventative manner. During recovery from any sprains, it’s useful to keep the leg elevated as much as is possible.

It is wise to take preventive measures to knee joint health because a severe injury could lead to a greater risk of ligament issues or, even arthritis in the long term:

  • Take a measured approach to increasing activity levels
  • Wear good fitting sports shoes
  • Warm up prior to exercising and stretch as part of the cool down process
  • Try low-impact exercises which will not injure the knee joints

Any injury to the knee joint could be costly. Damage to the joint will certainly affect movement, flexibility and, once weakened, it is likely that the individual will suffer from future pain or a reduction of mobility. According to Dr. Mininder Kocher, an orthopedics professor at Harvard Medical School, the potential to develop arthritis in the knee joint following a tear to a tendon or ligament is more than 50 percent. Therefore, treatment and due consideration to the health of the joint is paramount. Arthritis is very common and pain, swelling, and stiffness in the joint are typical.

The knee is a modified hinge joint which enables extension and flexion. It also enables external and internal rotation to a certain degree. There are three compartments; the patella (kneecap) the patellar groove on the front of the femur and the medial and lateral tibiofemoral articulations which connect the femur to the tibia. The joint capsule contains synovial membrane and fluid.

Knee joint pain can be considerable and where the severe injury occurs to the lateral collateral ligament (LCL) perhaps a severe sprain or if torn, the individual will experience stiffness, swelling, pain on the outside of the knee and a weakness in the joint. Partial LCL injuries may not demonstrate many symptoms. The LCL is one of four ligaments to help stabilize the joint but, this is the most common of LCL injuries.

It is easy to injure the LCL:

  • Over-stretching or over-use
  • Hyperextension of the knee
  • Twisting movements or a sudden change of direction

Injuries are graded accordingly. A grade 1 LCL sprain means that the ligament did not tear although there is the risk of further injury. A grade 11 LCL sprain means that there is partial tearing to the ligament and some symptoms will be experienced. When a grade 111 LCL sprain occurs, the ligament will have torn completely and there may be bleeding beneath the skin. If all the pain fibers are torn at the same time, there will be little to no pain.

Recovery – depending on the grade of injury may take up to four months. Minor injuries take much less healing time. Certainly, physiotherapy treatments will accelerate the healing process via massage, joint exercises, and electrical modalities. They will also guide the way that the knee ligament fibers heal. This can also help to reduce the potential to tear this ligament again. An MRI may be used for diagnostic purposes to be sure that there are no other combination injuries. Knee surgery may be required especially where there is a combination of injuries. Rehabilitation thereafter will focus on being able to increase strength to the joint and to restore the full motion of the knee. This will also help to reduce the risk of arthritis.

Continue Reading

Healing and Recovery for Shoulder Dislocations and Lesions

By  aenriquez  published  November 29, 2017

Recovery for Shoulder Dislocations The shoulder joint is extremely mobile enabling the upper arm to move in most directions with ease but, this also makes it an unstable joint and easy to injure. When a dislocation occurs, the pain can be significant and when the shoulder is severely injured, the nerves and tissues around the joint become damaged, resulting in ongoing weakness.

It is relatively easy to dislocate the shoulder joint:

  • Falling – in particular, landing directly on the shoulder on a hard surface.
  • Direct injury to the shoulder
  • Falling but the brunt of the weight is directed through an outstretched hand.
  • A sharp twist on the arm

Within the shoulder joint, the humerus head sits in the glenoid fossa, a shallow extension of the scapula, and, because of the shallowness of this area, the structures around the joint must maintain stability.  The labrum extends from the glenoid fossa and enables a deeper vessel for the head of the humerus. The tissues surrounding the joint also help to provide stability with tendons and rotator cuff muscles providing protection. When the head of the humerus is removed from its position in the socket, it is dislocated, and the type of dislocation is described by the positioning of where it is. Most dislocations are anterior dislocations – approximately 95%. This simply means that the humeral head moves in front of the joint. Posterior dislocations move towards the shoulder blade.

When the injury first happens, the shoulder can be immobilized by placing the arm in a sling and it can also be useful to apply an ice pack to the shoulder area. It is advisable to seek medical care so that a diagnosis can be made, and treatment given to repair the dislocated shoulder. The restricted movement to the upper arm and shoulder area and even some deformation of the shoulder is likely if it is dislocated. If the upper arm bone comes out of the shoulder socket, the force of this could tear the labrum, a ligament, causing a bankart lesion. It is common with dislocations to the shoulders and most connected to the instability of this joint. Initially, a doctor would be concerned with joint relocation and pain management, but to treat fully, they need to understand the circumstances of the injury and whether any dislocation has happened previously. Muscles spasms are likely and there will be various levels of pain.  Surgery, by way of a bankart repair, may be necessary.

The labrum – which is essentially a fibrous ring located within the shoulder socket, can be repaired following a small incision which enables the specialist to view the damage via a tiny camera. The damaged labrum and any other ligaments are re-attached and then, tightened using sutures or anchors. Surgery takes between 1.5 hours and 2.5 hours and a regional block are used to help numb the area. There is usually an overnight stay in the hospital, but the stitches must stay in place for up to 14-days.

Following surgery, the orthopedic surgeon may provide antibiotics and pain medication to ease pain and discomfort but also, as a preventative measure to prevent infection setting in. Ice packs are often recommended to help with any pain experienced. Physical therapy is also recommended during the recovery process to increase mobility. It is possible to recover completely from a shoulder dislocation although recovery may take some time, certainly, there are considerations to be made and older patients and those with diabetes could have a higher hospital admission rate.

 

Continue Reading